Sex in the shadow of HIV: A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa

Abstract

BackgroundEvidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa.MethodsStudies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10–24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted.Results610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored <50% in the quality checklist. Living with a partner, living alone, gender-based violence, food insecurity, and employment were correlated with increased sexual risk-taking, while knowledge of own HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs), three evaluated group-based interventions, and one evaluated an individual-focused combination intervention. Three of the interventions were effective at reducing sexual risk-taking, with one reporting no difference between the intervention and control groups.ConclusionSexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group.

What Proportion of Female Sex Workers Practise anal Intercourse and How Frequently? A Systematic Review and Meta-analysis

“…However, the role of anal intercourse (AI) within heterosexual epidemics has not been sufficiently examined and is frequently overlooked [4]. For example, recent reviews on HIV risk behaviour among female sex workers (FSW) in China [5] and among young people in Africa [6] examined multiple measures of sexual risk-taking but neither included AI practice. Likewise, public health messaging to FSW on HIV transmission seems to routinely neglect AI practice.…”

Adolescent and non-consensual anal sexual debut among Chinese men who have sex with men: a cross-sectional study

“…We de ned adolescent sexual debut as having anal sex with another man at 17 years old or younger, as 18 years old was considered to be adult in China, and having sex before 18 was considered to have sex early in China. (25) In addition, the participants were asked whether their rst maleto-male anal sex was non-consensual (coerced or unwilling to have sex with the partner).…”

Consistent Provisions Mitigate Exposure to Sexual Risk and HIV Among Young Adolescents in South Africa

“…Supporting adolescents to remain in school protects them from HIV infection, unintended adolescent pregnancy, and sexually transmitted infections [23], especially for adolescent girls [24,25]. To prevent new HIV infections among adolescents and young people, interventions need to address risk factors across the socioecological continuum [26][27][28][29]. However, among adolescents who remain enrolled in school, data is still needed to indicate which specific school-based provisions are most effective at preventing HIV infections and reducing early exposure to sexual risk.…”

“…While we know about risk and protective factors for HIV infection among older adolescent girls and young women, there is less evidence on sexual risk among adolescents living with HIV [29]. Research on reducing sexual risk exposure among young adolescents, for those who are HIV uninfected as well as those living with HIV, is critical to breaking the cycle of HIV transmission.…”